Introduced Version
HOUSE BILL No. 1018
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 5-10-8-9; IC 12-15; IC 12-21-9; IC 12-23-18;
IC 16-21-8.5; IC 27-8-5-15.8; IC 27-13-7-14.2.
Synopsis: Mental health and addiction matters. Specifies that an
individual's incarceration, hospitalization, or other temporary cessation
in substance or chemical use may not be used as a factor in determining
the individual's eligibility for coverage in: (1) a state employee health
care plan; (2) Medicaid; (3) the healthy Indiana plan; (4) a policy of
accident and sickness insurance; or (5) a health maintenance health
care contract. Requires an opioid treatment program to: (1) provide a
patient of the facility appropriate referrals for continuing care before
releasing the patient from care by the facility; and (2) counsel female
patients concerning the effects of the program treatment if the female
is or becomes pregnant and provide to the patient birth control if
requested by the patient. Requires the division of mental health and
addiction (division) to annually perform an audit of 20% of an opioid
treatment program facility's patient plans to ensure compliance with
federal and state laws and regulations. Requires the division to
establish a mental health and addiction program to reduce the stigma
of mental illness and addiction. Requires hospitals to establish
emergency room treatment protocols concerning treatment of a patient
who is overdosing, has been provided an overdose intervention drug,
or is otherwise identified as having a substance use disorder.
Effective: July 1, 2022.
Shackleford
January 4, 2022, read first time and referred to Committee on Public Health.
2022 IN 1018—LS 6278/DI 104 Introduced
Second Regular Session of the 122nd General Assembly (2022)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2021 Regular Session of the General Assembly.
HOUSE BILL No. 1018
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 5-10-8-9 IS AMENDED TO READ AS FOLLOWS
2 [EFFECTIVE JULY 1, 2022]: Sec. 9. (a) This section does not apply
3 if the application of this section would increase the premiums of the
4 health services policy or plan, as certified under IC 27-8-5-15.7, by
5 more than four percent (4%) as a result of complying with subsection
6 (c).
7 (b) As used in this section, "coverage of services for mental illness"
8 includes benefits with respect to mental health services as defined by
9 the contract, policy, or plan for health services. The term includes
10 services for the treatment of substance abuse and chemical dependency
11 when the services are required in the treatment of a mental illness.
12 (c) If the state enters into a contract for health services through
13 prepaid health care delivery plans, medical self-insurance, or group
14 health insurance for state employees, the contract may not permit
15 treatment limitations or financial requirements on the coverage of
16 services for mental illness if similar limitations or requirements are not
17 imposed on the coverage of services for other medical or surgical
2022 IN 1018—LS 6278/DI 104 2
1 conditions.
2 (d) This section subsection applies to a contract for health services
3 through prepaid health care delivery plans, medical self-insurance, or
4 group medical coverage for state employees that is issued, entered into,
5 or renewed after June 30, 1997. June 30, 2022. If the state enters into
6 a contract for health services through prepaid health care delivery
7 plans, medical self-insurance, or group health insurance for state
8 employees, the contract may not allow an individual's
9 incarceration, hospitalization, or other temporary cessation in
10 substance or chemical use to factor into a determination of an
11 individual's eligibility for coverage of the treatment of substance
12 abuse or chemical dependency.
13 (e) This section does not require the contract for health services to
14 offer mental health benefits.
15 SECTION 2. IC 12-15-5-13, AS AMENDED BY P.L.179-2019,
16 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
17 JULY 1, 2022]: Sec. 13. (a) The office shall provide coverage for
18 treatment of opioid or alcohol dependence that includes the following:
19 (1) Counseling services that address the psychological and
20 behavioral aspects of addiction.
21 (2) When medically indicated, drug treatment involving agents
22 approved by the federal Food and Drug Administration for the:
23 (A) treatment of opioid or alcohol dependence; or
24 (B) prevention of relapse to opioids or alcohol after
25 detoxification.
26 (3) When determined by the treatment plan to be medically
27 necessary, inpatient detoxification in accordance with the most
28 current edition of the American Society of Addiction Medicine
29 Patient Placement Criteria.
30 In determining eligibility for substance abuse treatment for a
31 recipient, the office or a managed care organization may not
32 consider an individual's incarceration, hospitalization, or other
33 temporary cessation in substance or chemical use as a factor to
34 deny eligibility.
35 (b) The office shall:
36 (1) develop quality measures to ensure; and
37 (2) require a managed care organization to report;
38 compliance with the coverage required under subsection (a).
39 (c) The office may implement quality capitation withholding of
40 reimbursement to ensure that a managed care organization has
41 provided the coverage required under subsection (a).
42 (d) The office shall report the clinical use of the medications
2022 IN 1018—LS 6278/DI 104 3
1 covered under this section to the mental health Medicaid quality
2 advisory committee established by IC 12-15-35-51. The mental health
3 Medicaid quality advisory committee may make recommendations to
4 the office concerning this section.
5 SECTION 3. IC 12-15-44.5-3.5, AS ADDED BY P.L.30-2016,
6 SECTION 28, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
7 JULY 1, 2022]: Sec. 3.5. (a) The plan must include the following in a
8 manner and to the extent determined by the office:
9 (1) Mental health care services.
10 (2) Inpatient hospital services.
11 (3) Prescription drug coverage, including coverage of a long
12 acting, nonaddictive medication assistance treatment drug if the
13 drug is being prescribed for the treatment of substance abuse.
14 (4) Emergency room services.
15 (5) Physician office services.
16 (6) Diagnostic services.
17 (7) Outpatient services, including therapy services.
18 (8) Comprehensive disease management.
19 (9) Home health services, including case management.
20 (10) Urgent care center services.
21 (11) Preventative care services.
22 (12) Family planning services:
23 (A) including contraceptives and sexually transmitted disease
24 testing, as described in federal Medicaid law (42 U.S.C. 1396
25 et seq.); and
26 (B) not including abortion or abortifacients.
27 (13) Hospice services.
28 (14) Substance abuse services.
29 (15) Pregnancy services.
30 (16) A service determined by the secretary to be required by
31 federal law as a benchmark service under the federal Patient
32 Protection and Affordable Care Act.
33 (b) The plan may not permit the following:
34 (1) Treatment limitations or financial requirements on the
35 coverage of mental health care services or substance abuse
36 services if similar limitations or requirements are not imposed on
37 the coverage of services for other medical or surgical conditions.
38 (2) In determining coverage for substance abuse treatment,
39 the plan may not factor in an individual's incarceration,
40 hospitalization, or other temporary cessation in substance or
41 chemical use when determining the individual's eligibility for
42 the treatment.
2022 IN 1018—LS 6278/DI 104 4
1 (c) The plan may provide vision services and dental services only
2 to individuals who regularly make the required monthly contributions
3 for the plan as set forth in section 4.7(c) of this chapter.
4 (d) The benefit package offered in the plan:
5 (1) must be benchmarked to a commercial health plan described
6 in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
7 (2) may not include a benefit that is not present in at least one (1)
8 of these commercial benchmark options.
9 (e) The office shall provide to an individual who participates in the
10 plan a list of health care services that qualify as preventative care
11 services for the age, gender, and preexisting conditions of the
12 individual. The office shall consult with the federal Centers for Disease
13 Control and Prevention for a list of recommended preventative care
14 services.
15 (f) The plan shall, at no cost to the individual, provide payment of
16 preventative care services described in 42 U.S.C. 300gg-13 for an
17 individual who participates in the plan.
18 (g) The plan shall, at no cost to the individual, provide payments of
19 not more than five hundred dollars ($500) per year for preventative
20 care services not described in subsection (f). Any additional
21 preventative care services covered under the plan and received by the
22 individual during the year are subject to the deductible and payment
23 requirements of the plan.
24 SECTION 4. IC 12-21-9 IS ADDED TO THE INDIANA CODE AS
25 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
26 1, 2022]:
27 Chapter 9. Mental Health Education Program
28 Sec. 1. The division shall establish and administer a statewide
29 program to reduce the stigma of mental illness and addiction in
30 Indiana.
31 Sec. 2. The program must include the following:
32 (1) Awareness raising interventions, including signs or
33 symptoms that an individual may be suffering from a mental
34 illness or addiction.
35 (2) Literacy programs to improve knowledge of mental
36 illnesses and addiction.
37 (3) Dissemination of lists of resources available on a regional
38 basis to individuals who believe they are suffering from a
39 mental illness or addiction.
40 (4) The benefits of obtaining services to treat a mental illness
41 or addiction.
42 (5) Dissemination of educational materials targeted to
2022 IN 1018—LS 6278/DI 104 5
1 different ages and populations.
2 SECTION 5. IC 12-23-18-0.5, AS AMENDED BY P.L.8-2016,
3 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
4 JULY 1, 2022]: Sec. 0.5. (a) An opioid treatment program shall not
5 operate in Indiana unless the opioid treatment program meets the
6 following conditions:
7 (1) Is specifically approved and the opioid treatment facility is
8 certified by the division.
9 (2) Is in compliance with state and federal law.
10 (3) Provides treatment for opioid addiction using a drug approved
11 by the federal Food and Drug Administration for the treatment of
12 opioid addiction, including:
13 (A) opioid maintenance;
14 (B) detoxification;
15 (C) overdose reversal;
16 (D) relapse prevention; and
17 (E) long acting, nonaddictive medication assisted treatment
18 medications.
19 (4) Beginning July 1, 2017, is:
20 (A) enrolled:
21 (i) as a Medicaid provider under IC 12-15; and
22 (ii) as a healthy Indiana plan provider under IC 12-15-44.2;
23 or
24 (B) enrolled as an ordering, prescribing, or referring provider
25 in accordance with Section 6401 of the federal Patient
26 Protection and Affordable Care Act (P.L. 111-148), as
27 amended by the federal Health Care and Education
28 Reconciliation Act of 2010 (P.L. 111-152) and maintains a
29 memorandum of understanding with a community mental
30 health center for the purpose of ordering, prescribing, or
31 referring treatments covered by Medicaid and the healthy
32 Indiana plan.
33 (5) Provides to a patient of the opioid treatment facility who
34 is being released from the program referrals to appropriate
35 providers to continue the care that:
36 (A) the facility deems appropriate for the patient; or
37 (B) the patient requests;
38 before the patient's release from care of the facility.
39 (b) Separate specific approval and certification under this chapter
40 is required for each location at which an opioid treatment program is
41 operated. If an opioid treatment program moves the opioid treatment
42 program's facility to another location, the opioid treatment program's
2022 IN 1018—LS 6278/DI 104 6
1 certification does not apply to the new location and certification for the
2 new location under this chapter is required.
3 (c) Each opioid treatment program that is enrolled as an ordering,
4 prescribing, or referring provider shall report to the office on an annual
5 basis the services provided to Indiana Medicaid patients. The report
6 must include the following:
7 (1) The number of Medicaid patients seen by the ordering,
8 prescribing, or referring provider.
9 (2) The services received by the provider's Medicaid patients,
10 including any drugs prescribed.
11 (3) The number of Medicaid patients referred to other providers.
12 (4) Any other provider types to which the Medicaid patients were
13 referred.
14 SECTION 6. IC 12-23-18-5, AS AMENDED BY P.L.181-2021,
15 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
16 JULY 1, 2022]: Sec. 5. (a) The division shall adopt rules under
17 IC 4-22-2 to establish the following:
18 (1) Standards for operation of an opioid treatment program in
19 Indiana, including the following requirements:
20 (A) Except as otherwise prescribed by the division, an opioid
21 treatment program shall obtain prior authorization from the
22 division for any patient receiving more than fourteen (14) days
23 of opioid maintenance treatment medications at one (1) time
24 and the division may approve the authorization only under the
25 following circumstances:
26 (i) A physician licensed under IC 25-22.5 has issued an
27 order for the opioid treatment medication.
28 (ii) The patient has not tested positive under a drug test for
29 a drug for which the patient does not have a prescription for
30 a period of time set forth by the division.
31 (iii) The opioid treatment program has determined that the
32 benefit to the patient in receiving the take home opioid
33 treatment medication outweighs the potential risk of
34 diversion of the take home opioid treatment medication.
35 (B) Minimum requirements for a licensed physician's regular:
36 (i) physical presence in the opioid treatment facility; and
37 (ii) physical evaluation and progress evaluation of each
38 opioid treatment program patient.
39 (C) Minimum staffing requirements by licensed and
40 unlicensed personnel.
41 (D) Clinical standards for the appropriate tapering of a patient
42 on and off of an opioid treatment medication.
2022 IN 1018—LS 6278/DI 104 7
1 (E) The provision of counseling to female patients upon
2 admission and periodically through the patient's treatment
3 by the facility concerning the effects of the program
4 treatment if the female is or becomes pregnant, and the
5 provision to the patient of birth control if requested by the
6 patient.
7 (2) A requirement that, not later than February 28 of each year, a
8 current diversion control plan that meets the requirements of 21
9 CFR Part 290 and 42 CFR Part 8 be submitted for each opioid
10 treatment facility.
11 (3) Fees to be paid by an opioid treatment program for deposit in
12 the fund for annual certification under this chapter as described
13 in section 3 of this chapter.
14 The fees established under this subsection must be sufficient to pay the
15 cost of implementing this chapter.
16 (b) The division shall conduct an annual onsite visit of each opioid
17 treatment program facility to assess compliance with this chapter. As
18 part of an annual onsite visit, the division shall audit at least twenty
19 percent (20%) of the opioid treatment program facility's patient
20 plans to determine whether the facility is complying with federal
21 and state rules and regulations, including the following:
22 (1) Meeting tapering standards established by the division
23 under subsection (a)(1)(D).
24 (2) Complying with the goal of providing a patient with the
25 minimal clinically necessary medication dose, with the goal of
26 opioid abstinence as set forth in section 5.3 of this chapter.
27 (3) Performing and complying with the drug testing
28 requirements for patients set forth in section 2.5 of this
29 chapter.
30 (4) Racial demographics of the patients.
31 Any personally identifying information and medical information
32 of a patient obtained through the audit are confidential.
33 (c) Not later than April 1 of each year, the division shall report to
34 the general assembly in electronic format under IC 5-14-6 the
35 following information:
36 (1) The number of prior authorizations that were approved under
37 subsection (a)(1)(A) in the previous year and the:
38 (A) time frame for each approval; and
39 (B) duration of each approved treatment.
40 (2) The number of authorizations under subdivision (1) that were,
41 in the previous year, revoked due to a patient's violation of an
42 applicable term or condition.
2022 IN 1018—LS 6278/DI 104 8
1 (3) The number of each of the actions taken under section 5.8(a)
2 of this chapter in the previous year.
3 (4) The number and type of violations assessed for each action
4 specified in section 5.8(a) of this chapter in the previous year.
5 (d) A facility shall report, in a manner prescribed by the division, all
6 information required by the division to complete the report described
7 in subsection (c).
8 SECTION 7. IC 16-21-8.5 IS ADDED TO THE INDIANA CODE
9 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
10 JULY 1, 2022]:
11 Chapter 8.5. Emergency Room Treatment of Patients With
12 Substance Use Disorders
13 Sec. 1. Not later than January 1, 2023, a hospital licensed under
14 this article shall have established protocols on the emergency room
15 treatment of a patient who:
16 (1) is overdosing on a substance;
17 (2) has been provided an overdose intervention drug
18 immediately prior to being transported to the hospital; or
19 (3) is otherwise identified as having a substance use disorder.
20 Sec. 2. The protocols required in section 1 of this chapter must
21 include the following:
22 (1) An assessment of the patient before discharge by a
23 provider whose scope of practice includes providing
24 treatment for an individual with a substance use disorder,
25 including:
26 (A) a physician licensed under IC 25-22.5;
27 (B) a psychologist licensed under IC 25-33;
28 (C) an addiction counselor or a clinical addiction counselor
29 licensed under IC 25-23.6-10.5; or
30 (D) a person described in IC 25-23.6-10.1-2.
31 (2) Treatment, assistance in obtaining treatment, or a referral
32 to treatment to a provider described in subdivision (1).
33 Sec. 3. The hospital shall provide training on the protocols to
34 any staff or contractor providing services in the emergency
35 department of the hospital.
36 SECTION 8. IC 27-8-5-15.8, AS ADDED BY P.L.103-2020,
37 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
38 JULY 1, 2022]: Sec. 15.8. (a) As used in this section, "treatment of a
39 mental illness or substance abuse" means:
40 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
41 and
42 (2) treatment for drug abuse or alcohol abuse.
2022 IN 1018—LS 6278/DI 104 9
1 (b) As used in this section, "act" refers to the Paul Wellstone and
2 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
3 any amendments thereto, plus any federal guidance or regulations
4 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
5 CFR 147.160, and 45 CFR 156.115(a)(3).
6 (c) As used in this section, "nonquantitative treatment limitations"
7 refers to those limitations described in 26 CFR 54.9812-1, 29 CFR
8 2590.712, and 45 CFR 146.136.
9 (d) An insurer that issues a policy of accident and sickness
10 insurance that provides coverage of services for treatment of a mental
11 illness or substance abuse shall submit a report to the department not
12 later than December 31 of each year that contains the following
13 information:
14 (1) A description of the processes:
15 (A) used to develop or select the medical necessity criteria for
16 coverage of services for treatment of a mental illness or
17 substance abuse; and
18 (B) used to develop or select the medical necessity criteria for
19 coverage of services for treatment of other medical or surgical
20 conditions.
21 (2) Identification of all nonquantitative treatment limitations that
22 are applied to:
23 (A) coverage of services for treatment of a mental illness or
24 substance abuse; and
25 (B) coverage of services for treatment of other medical or
26 surgical conditions;
27 within each classification of benefits.
28 (e) Coverage of treatment of a mental illness or substance abuse
29 must meet the following:
30 (1) There may be no separate nonquantitative treatment
31 limitations that apply to coverage of services for treatment of a
32 mental illness or substance abuse that do not apply to coverage of
33 services for treatment of other medical or surgical conditions
34 within any classification of benefits.
35 (2) An individual's incarceration, hospitalization, or other
36 temporary cessation in substance or chemical use may not
37 factor into a determination of the individual's eligibility for
38 coverage of the treatment of mental illness or substance
39 abuse.
40 (f) An insurer that issues a policy of accident and sickness insurance
41 that provides coverage of services for treatment of a mental illness or
42 substance abuse shall also submit an analysis showing the insurer's
2022 IN 1018—LS 6278/DI 104 10
1 compliance with this section and the act to the department not later
2 than December 31 of each year. The analysis must do the following:
3 (1) Identify the factors used to determine that a nonquantitative
4 treatment limitation will apply to a benefit, including factors that
5 were considered but rejected.
6 (2) Identify and define the specific evidentiary standards used to
7 define the factors and any other evidence relied upon in designing
8 each nonquantitative treatment limitation.
9 (3) Provide the comparative analyses, including the results of the
10 analyses, performed to determine the following:
11 (A) That the processes and strategies used to design each
12 nonquantitative treatment limitation for coverage of services
13 for treatment of a mental illness or substance abuse are
14 comparable to, and applied no more stringently than, the
15 processes and strategies used to design each nonquantitative
16 treatment limitation for coverage of services for treatment of
17 other medical or surgical conditions.
18 (B) That the processes and strategies used to apply each
19 nonquantitative treatment limitation for treatment of a mental
20 illness or substance abuse are comparable to, and applied no
21 more stringently than, the processes and strategies used to
22 apply each nonquantitative limitation for treatment of other
23 medical or surgical conditions.
24 (g) The department shall adopt rules to ensure compliance with this
25 section and the applicable provisions of the act.
26 SECTION 9. IC 27-13-7-14.2, AS ADDED BY P.L.103-2020,
27 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
28 JULY 1, 2022]: Sec. 14.2. (a) As used in this section, "treatment of a
29 mental illness or substance abuse" means:
30 (1) treatment for a mental illness, as defined in IC 12-7-2-130(1);
31 and
32 (2) treatment for drug abuse or alcohol abuse.
33 (b) As used in this section, "act" refers to the Paul Wellstone and
34 Pete Domenici Mental Health Parity and Addiction Act of 2008 and
35 any amendments thereto, plus any federal guidance or regulations
36 relevant to that act, including 45 CFR 146.136, 45 CFR 147.136, 45
37 CFR 147.160, and 45 CFR 156.115(a)(3).
38 (c) As used in this section, "nonquantitative treatment limitations"
39 refers to those limitations described in 26 CFR 54.9812-1, 29 CFR
40 2590.712, and 45 CFR 146.136.
41 (d) An individual contract or a group contract that provides
42 coverage of services for treatment of a mental illness or substance
2022 IN 1018—LS 6278/DI 104 11
1 abuse shall submit a report to the department not later than December
2 31 of each year that contains the following information:
3 (1) A description of the processes:
4 (A) used to develop or select the medical necessity criteria for
5 coverage of services for treatment of a mental illness or
6 substance abuse; and
7 (B) used to develop or select the medical necessity criteria for
8 coverage of services for treatment of other medical or surgical
9 conditions.
10 (2) Identification of all nonquantitative treatment limitations that
11 are applied to:
12 (A) coverage of services for treatment of a mental illness or
13 substance abuse; and
14 (B) coverage of services for treatment of other medical or
15 surgical conditions;
16 within each classification of benefits.
17 (e) Coverage of treatment of a mental illness or substance abuse
18 must meet the following:
19 (1) There may be no separate nonquantitative treatment
20 limitations that apply to coverage of services for treatment of a
21 mental illness or substance abuse that do not apply to coverage of
22 services for treatment of other medical or surgical conditions
23 within any classification of benefits.
24 (2) An individual's incarceration, hospitalization, or other
25 temporary cessation in substance or chemical use may not
26 factor into a determination of the individual's eligibility for
27 coverage of the treatment of mental illness or substance
28 abuse.
29 (f) An individual contract or a group contract that provides coverage
30 of services for treatment of a mental illness or substance abuse shall
31 also submit an analysis showing the insurer's compliance with this
32 section and the act to the department not later than December 31 of
33 each year. The analysis must do the following:
34 (1) Identify the factors used to determine that a nonquantitative
35 treatment limitation will apply to a benefit, including factors that
36 were considered but rejected.
37 (2) Identify and define the specific evidentiary standards used to
38 define the factors and any other evidence relied upon in designing
39 each nonquantitative treatment limitation.
40 (3) Provide the comparative analyses, including the results of the
41 analyses, performed to determine the following:
42 (A) That the processes and strategies used to design each
2022 IN 1018—LS 6278/DI 104 12
1 nonquantitative treatment limitation for coverage of services
2 for treatment of a mental illness or substance abuse are
3 comparable to, and applied no more stringently than, the
4 processes and strategies used to design each nonquantitative
5 treatment limitation for coverage of services for treatment of
6 other medical or surgical conditions.
7 (B) That the processes and strategies used to apply each
8 nonquantitative treatment limitation for treatment of a mental
9 illness or substance abuse are comparable to, and applied no
10 more stringently than, the processes and strategies used to
11 apply each nonquantitative limitation for treatment of other
12 medical or surgical conditions.
13 (g) The department shall adopt rules to ensure compliance with this
14 section and the applicable provisions of the act.
2022 IN 1018—LS 6278/DI 104